Conversion of Laparoscopic Cholecystectomy to Open Cholecystectomy: An Analysis in a High Risk Group of Patients

Abstract

Background: Laparoscopic cholecystectomy (LC) has revolutionized minimally invasive surgery, considered as gold standard and increasing number of procedures are done for patients with various high risk comorbid conditions. LC today can be as straightforward operation, but may also be an operative approach fraught with underlying complexities necessitating conversion to open cholecystectomy leading to longer operative time, longer hospital stay and more postoperative morbidity and higher hospital costs. We have tried to estimate the rate and risk factors which are associated with the conversion. Materials and methods: In this prospective and retrospective hospital based observational study, we included 134 patients that underwent Laparoscopic cholecystectomy and laparoscopy converted to open cholecystectomy from May 2012 to May 2016. Patient records were analyzed and their demographic, physical and clinical examination details were taken into account. Results: 134 patients were enrolled for Laparoscopic cholecystectomy (LC), 12 patients (8.9 %) converted to open cholecystectomy. In conversion group American Society of Anaesthesiologist’s (ASA III) and American Society of Anaesthesiologist’s (ASA IV) categories predominate with American Society of Anaesthesiologist’s (ASA IV) constitute about (66.7 %) of patients. Patients in age group 40-60years dominated study. Coronary artery disease (CAD) with Stent presents in (8.3 %) and CAD with previous surgical intervention as coronary artery bypass surgery (CABG) in (16.7 %) in converted group. Most common reason for conversion were adhesion in calot’s triangle in 9/12 (75 %) of patients. Increase was noted in operative time by more than 30 minutes, postoperative complication by 25 % and total hospital stay by 24hours as compared to Laparoscopic cholecystectomy group. Conclusions: A thorough review of all the risk factors if performed based on the physical, clinical, comorbid status and intraoperative findings helps the surgeon in proper patient counselling and early conversion to open cholecystectomy for patient safety.